Tirapazamine (TPZ) is a bioreductive agent with selective antitumor activity under hypoxic conditions; however, its systemic toxicity and delivery efficiency limit its clinical application. This study aimed to develop a TPZ delivery system based on nanobubbles (NBs), combining ultrasound-targeted microbubble destruction (UTMD) and transcatheter arterial chemoembolization (TACE) for treating hepatocellular carcinoma (HCC) to enhance therapeutic efficacy and reduce adverse effects. TPZ-NBs were fabricated using a high-shear dispersion method and characterized for their physicochemical properties, encapsulation efficiency, and drug release profiles. In vitro studies evaluated the effects of TPZ-NBs on hepatoma cell proliferation and migration under hypoxic conditions. Using a rabbit VX2 liver cancer model, we compared the control group, TACE group, TPZ-NBs + TACE group, and TPZ-NBs + UTMD + TACE group in terms of tumor necrosis, drug delivery efficiency, and safety profiles. TPZ-NBs demonstrated favorable encapsulation efficiency (35.81

T-cell receptor (TCR) sequencing provides a novel platform for insight into and characterization of intricate T-cell profiles, advancing the understanding of tumor immune heterogeneity. Recently, transarterial chemoembolization (TACE) combined with systemic therapy has become the recommended regimen for advanced hepatocellular carcinoma. The regulation of the immune microenvironment after TACE and its impact on tumor progression and recurrence has been a focus of research. By examining and tracking fluctuations in the TCR repertoire following combination treatment, novel perspectives on the modulation of the tumor microenvironment post-TACE and the underlying mechanisms governing tumor progression and recurrence can be gained. Clarifying the distinctive metrics and dynamic alterations of the TCR repertoire within the context of combination therapy is imperative for understanding the mechanisms of anti-tumor immunity, assessing efficacy, exploiting novel treatments, and further advancing precision oncology in the treatment of hepatocellular carcinoma. In this review, we initially summarized the fundamental characteristics of TCR repertoire and depicted immune microenvironment remodeling after TACE. Ultimately, we illustrated the prospective applications of TCR repertoires in TACE combined with systemic therapy.

患者 女,75岁.因右侧上颌骨肿物1月余人院.查体:右侧颌面部肿胀,右上颚可见一大小约4 cm×5 cm×5 cm的肿块,表面呈暗红色糜烂菜花状,边缘隆起伴出血(图1),病理活检示低分化鳞状细胞癌.实验室检查无明显异常.增强CT示右侧上颌骨骨质破坏并软组织占位,大小约6.1 cm×4.7 cm×4.3 cm,中度不均匀强化(图2).多学科会诊后拟行介入治疗.

1 临床资料 患者女,43岁.因"右外耳道肿物外科根治术后复发2年余"入院.6年前因右外耳道肿物行外科根治切除,术后病理示:腺样囊性癌(adenoid cystic carcinoma,ACC).2年前右颌面区肿痛,穿刺活检病理示ACC,确诊复发,自行口服中药治疗(具体不详).后肿块逐渐增大,肿瘤科以"卡铂+长春瑞滨"方案化疗2周期,未缓解,遂转至介入科进一步治疗.

1 临床资料 患者,男,50岁.因"双下肢肿痛11 d"入院.11 d前无明显诱因出现双下肢肿痛,为凹陷性水肿.当地医院腹部超声提示肝硬化、肝实性结节、肝右静脉至下腔静脉内栓子.既往乙肝病史20余年.实验室检查:ALT 240 U/L,AST 192 U/L,Alb 38.8 g/L,肌酐132μmol/L,AFP 4.52 ng/mL,CA12564.7 U/mL,余无明显异常.

目的 探讨DSA引导下血管腔内钳夹病理活检术(IVFPB)临床初步应用的安全性、可行性及临床价值.方法 回顾性分析2016年1月至2021年1月行DSA下IVFPB的16例患者的临床资料,随访时间1～6个月,分析IVFPB技术成功率、病理诊断阳性率及安全性,探讨其临床意义.结果 16例患者中,男10例,女6例;临床诊断肝癌、肺癌、肾盂癌、睾丸癌、胸腺瘤、乳腺癌、下肢动脉硬化闭塞各1例、肝硬化4例、布加综合征5例;15例经静脉途径行IVFPB,经动脉途径1例.IVFPB技术成功率及病检阳性率均为100％.病理诊断分别为低分化肝细胞癌、低分化大细胞肺癌、高分化尿路上皮癌、低分化睾丸腺癌、侵袭性胸腺瘤、炎性渗出物、纤维组织及纤维性渗出物、纤维组织增生伴炎症细胞浸润、肝硬化G2S4、下腔静脉纤维组织及渗出各1例,红色血栓2例、纤维结缔组织伴玻璃样变/局灶黏液变4例.活检过程及随访期间均无严重并发症发生.后续依据病理结果给予个体化治疗.结论 IVFPB临床初步应用技术安全、可行,阳性率高;对肿瘤精准治疗及病因病理学研究有较高的临床价值,是临床病检方法的一个重要补充.

目的 探讨经动脉化疗栓塞治疗头颈部恶性肿瘤的近期疗效及安全性方法 回顾性分析25例头颈部恶性肿瘤患者的临床资料,所有患者均经病理学确诊,其中经导管动脉栓塞术(TAE)7例,经导管动脉化疗栓塞术(TACE)18例.所有患者随访至2021年3月10日,随访终点为患者死亡.对比术前及术后1、3、6、12个月实验室及影像学检查评估近期疗效,根据术后有无并发症评估安全性.对随访结果进行统计学分析,记录总生存期(OS)及无进展生存期(PFS).结果 25例患者共行介入治疗46次,平均(1.76±0.88)次;随访1～48个月,平均随访(26.80±4.77)个月.介入治疗后近期内患者症状、肿瘤负荷均有不同程度缓解,术后1、3、6、12个月的客观缓解率分别为 84％(21/25)、76％(19/25)、40％(10/25)、28％(7/25),疾病控制率分别为 100％(25/25)、88％(22/25)、64％(16/25)、32％(8/25).术后皮肤破溃发生率为16％(4/25),无严重不良事件发生.中位OS为15个月[95％CI(13.25,16.75)],中位PFS 12个月[95％CI(6.33,17.67)].结论 经动脉化疗栓塞治疗头颈部恶性肿瘤近期临床疗效确切,安全有效.

1临床资料 患者女,56岁.以"胆囊癌介入治疗4月余,皮肤巩膜黄染1周"为主诉入院.4个月前因"腹胀、腹部隐痛"确诊为胆囊癌伴肝转移.决定行介入治疗及系统治疗,肝动脉造影后留管,给予氟尿嘧啶1 500 mg+奥沙利铂100 mg持续灌注化疗,配合口服阿帕替尼500 mg/d,好转出院.2个月后复查,疗效评价为部分缓解(PR),行肝动脉造影并动脉灌注化疗,方案同前.

目的 探讨CalliSpheres载药微球经动脉化疗栓塞(DEB-TACE)加载不同药物治疗肝细胞癌的疗效及安全性.方法 回顾性分析行DEB-TACE治疗150例肝细胞癌患者的临床资料,其中载药微球加载吡柔比星(A组)、雷替曲塞(B组)、三氧化二砷(C组)各50例,随访46个月.比较治疗前与治疗后1个月患者的肝功能和AFP变化,评估术后1、3和6个月的疗效及相关不良反应,比较各组患者的生存期(OS)及无进展生存期(PFS).结果 治疗后1个月,3组患者肝功能均有不同程度好转,AFP≥400μg/L例数均较治疗前减少,特别是C组患者治疗前后差异有统计学意义(P=0.009).治疗后3组患者肝功能指标比较差异无统计学意义(P＞0.05),C组AFP≥400μg/L的例数少于其他两组,差异有统计学意义(P＜0.05).治疗后1个月,A、B、C 3组患者的ORR分别为86％、68％和84％,其中A组与B组比较差异有统计学意义(P=0.032);3组患者的DCR分别为94％、88％和98％,差异无统计学意义(P＞0.05).治疗后3个月,3组患者的ORR分别为74％、44％和70％,A组与C组均高于B组,差异有统计学意义(P=0.002、0.009);3组DCR分别为86％、66％和80％,其中A组与B组比较差异有统计学意义(P=0.019).治疗后6个月,3组患者的ORR分别为54％、46％和48％,DCR分别为66％、66％和62％,差异均无统计学意义(P＞0.05).A组、B组和C组患者的OS分别为32.5个月、22.1个月和24.9个月,差异无统计学意义(P＞0.05);PFS分别为10.1个月、8.5个月和12.0个月,差异无统计学意义(P＞0.05).3组不良反应主要表现均为栓塞后综合征和骨髓抑制,B组不良反应发生率相对较低.结论 CalliSpheres载药微球加载吡柔比星及三氧化二砷治疗HCC近期疗效优于雷替曲塞,加载不同药物对患者远期生存无显著影响,技术均安全可行.

目的 探讨介入治疗肢体动静脉畸形(AVM)的临床效果.方法 回顾性分析2015年1月至2020年10月在郑州大学第一附属医院接受介入治疗的11例肢体AVM患者临床资料,其中男5例,女6例,年龄为(36.3±19.2)岁.所有患者均有典型临床表现,如异常血管搏动、杂音等.9例行经动脉途径栓塞,2例行直接经皮穿刺栓塞,栓塞剂为聚乙烯醇(PVA)颗粒(粒径350～560 μm、560～710 μm)、医用组织胶、弹簧圈及无水乙醇.结果 4例患者治愈,4例明显缓解,3例缓解,临床治疗成功8例.1例患者经历4次介入手术、外科局部清创术,肌间血肿治愈,心力衰竭缓解.无严重并发症发生.结论 介入治疗肢体AVM具有微创、安全、可重复等优势,近期疗效确切.

1 临床资料 患者男,32岁.以"胸闷、胸痛2个月余"为主诉入院.患者2个月前无明显诱因出现胸闷、胸痛、咯痰、心慌等症状,至当地医院就诊,胸部CT示,纵隔及右肺占位,未治疗.后至本中心肿瘤科就诊,穿刺病理活检示纵隔神经内分泌肿瘤(NEN),免疫组化符合非典型类癌.实验室检查:肿瘤异常糖链蛋白TAP 209.8,肝肾功能、血常规、凝血功能等无异常.

患者 女,76岁.右上腹间断疼痛3个月,黄疸1月余.体检:全身皮肤黏膜巩膜黄染.上腹部CT扫描示肝门部胆管占位伴肝内胆管扩张.实验室检查:CEA19.50 ng/ml,CA-125 698.0 U/ml,CA-199 11314.0 U/ml,ALT 92 U/L,AST 148 U/L,ALB 29.4 g/L,TBIL 127.72 μmol/L,BILD 116.71μmol/L,凝血功能无异常.

RATIONALE AND OBJECTIVES:To develop and validate a nomogram for the prediction of stent dysfunction after transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with hepatitis B cirrhosis.MATERIALS AND METHODS:From 2012 to 2020, 355 patients with hepatitis B cirrhosis who underwent TIPS placements were enrolled in this study. A multivariable logistic regression analysis was applied to determine independent risk factors for the nomogram construction. Discrimination, calibration, and clinical usefulness of the prediction model were assessed by using receiver operating characteristic curves, calibration scatter plots, and a decision curve analysis (DCA).RESULTS:Independent factors for TIPS stent dysfunction included diabetes, previous splenectomy, the shunting branch of the portal vein, and stent position, which were used to construct the nomogram. The AUC values in the training and validation cohorts were 0.817 (95% CI: 0.731-0.903) and 0.804 (95% CI: 0.673-0.935), respectively, which suggested a good predictive ability. The calibration curves in both cohorts revealed good agreement between the predictions and actual observations. The DCA curve indicated that when the threshold probability ranged from 2% to 88%, the nomogram could provide clinical usefulness and a net benefit.CONCLUSION:The nomogram that we developed could be conveniently used to predict TIPS stent dysfunction in patients with hepatitis B cirrhosis.

目的 探讨介入治疗胆管支气管瘘(BBF)的初步疗效和安全性.方法 回顾性分析2013年7月至2018年10月经本科收治的3例获得性BBF患者的临床资料,临床均表现为发热、咳嗽、咳胆色素痰症状,结合患者症状体征、实验室检查及影像学检查确诊为BBF,在DSA引导下行经皮经肝胆管穿刺引流术(PTCD)及抗感染治疗.结果 3例患者手术均顺利,造影可见胆管与支气管相通,其中2例治愈,症状明显改善;1例死于肝功能衰竭.结论 介入治疗BBF初步疗效肯定、安全性高.

Background:Patients who survive initial esophagogastric variceal bleeding (EVB) are at an increased risk of recurrent bleeding and death; however, a reliable predictive model is lacking. We aimed to develop a model for rebleeding prediction in patients with EVB after modified percutaneous transhepatic variceal embolization (PTVE) with cyanoacrylate.Methods:A total of 122 patients with EVB who underwent PTVE from January 2015 to November 2020 were enrolled. Multivariate logistic analyses were conducted to determine independent risk factors for nomogram construction. The discrimination, calibration, and clinical utility of the nomogram were compared with the Model for End-stage Liver Disease score (MELD) and the Child-Pugh model. Risk stratification was performed according to the nomogram.Results:Rebleeding within 3 months of PTVE occurred in 32 patients (26.2%). Independent rebleeding indicators included prior history of endoscopic therapy, Child-Pugh score, partial splenic embolization, and creatinine level. The nomogram incorporating these four predictors achieved excellent calibration and discriminatory abilities, with a concordance index of 0.85, which was confirmed to be 0.83 through bootstrapping validation. The nomogram demonstrated superior discrimination and clinical applicability than the MELD and Child-Pugh models. As shown in the Kaplan-Meier curves, high-risk patients had a high probability of rebleeding (P ​< ​0.001).Conclusions:The creatinine-based nomogram had a superior ability to predict rebleeding after PTVE in patients with EVB. Risk stratification may help identify high-risk patients and lead to the earlier implementation of aggressive treatments and formulation of intensive follow-up plans.

A 75-year-old woman presented with a 2-month history of right-sided maxillofacial swelling and difficulty with opening the mouth and chewing. Physical examination revealed a 4-cm × 5-cm × 5-cm, dark-red, surface-eroded, bleeding right upper oral mass (Fig 1). Biopsy and pathological examination revealed poorly differentiated squamous cell carcinoma. Computed tomography (CT) showed bone destruction and a 6.1-cm × 4.7-cm × 4.3-cm soft tissue mass in the right maxilla with moderately heterogeneous enhancement (Fig 2).

With the development of detection methods, various biomarkers of liver cancer have been detected constantly, which is of great significance for the early diagnosis and real-time monitoring of liver cancer after treatment. Based on the differences in the sensitivity and specificity of different biomarkers, exploration of the value of diverse biomarkers in the diagnosis and prognosis assessment of liver cancer can provide an important reference for clinicians to scientific and rational application of distinct biomarkers.

目的:评价经导管动脉栓塞(TAE)治疗获得性子宫动静脉畸形的有效性.方法:回顾性分析接受TAE治疗的7例确诊为获得性子宫动静脉畸形患者的临床资料.患者年龄21～45岁,术前均完善血常规、系列β人绒毛膜促性腺激素等检查,彩色多普勒超声、CTA或MRI等影像检查.TAE栓塞材料有明胶海绵颗粒、聚乙烯醇颗粒(PVA).结果:7例共接受9次TAE,全部成功.所有患者首次TAE治疗后3～10周月经恢复正常.3例治疗后成功妊娠,其中2例成功足月顺产;1例妊娠24周后流产,再行2次栓塞后痊愈.2例术后出现栓塞后综合征,表现为发热、恶心、腹痛等,经对症治疗3～7 d后消失.均无严重并发症发生.结论:TAE治疗获得性子宫动静脉畸形安全有效,可保留生育功能.

随着腔镜技术的快速发展,腔镜下钳夹病理活检术已被广泛应用于临床病理诊断,常用于消化道和呼吸道病理活检[1].近年来,DSA下胆道钳夹病理活检得到创新性的发展和应用,解决了胆道病理诊断困难的难题[2-3].但以上均为非血管腔道钳夹病理活检的报道,而有关血管腔内钳夹病理活检术(endovascular forceps pathological biopsy,EFPB)的应用报道较少,本研究将该技术应用于2例患者,均获得阳性结果,且无并发症发生,现将初步经验总结如下. 临床资料